HomeMy WebLinkAboutMortgage_Hayden (2)^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun ovm ' ear
__ - FOR DEDUCTION FROM ASSESSED VALUATION
� saca Form as�os {ai i i s�>
� r�. , Presm'bed by OeG�ent of Lod Govemment Finarrx
I
INSTRUCT70NS:
To be fifed in person or by mad with the CounryAuditor or County RecoNer o( the county where the pioperty is located. ���
Fifirg Dates: 7J Real Property. Must file durirg the year for whicM1 the deductlon is sought � ��ryC�
2) be�fore March 3� e°yhomes rat assessed as Real Property: Must fi!e during the hvefve (12J month��gs N� NT V pu8�
year the dedudion is soughG CBUnty R er
See reverse side lor additional instructions and qualificaGOns.
�.�d�,���
Metd� 7, mrent year
fIQ WF3� IS NS J Ml C22CT SI12(8 Oi Il1iClP5i)
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Name of moR9a9ee or contratlSNler
ndaress or mortgayee «cmaaa
o»ner
� - a -`a/.�3�DQ
rtgage / Contract indehtedness unpaid as ot MMgage I CartVai
fch 1. wrtent yeer data af appOptmn
i
IF awned wiN someone aUw�
r��e oerow
svee4 �rtl: state. alM ZIP code)
streef, dry, state, and LP cotle)
Dces ePPlirant own property in any olher
munry m IMFana?
❑ Yes
zo _ � zo _ � zo
20
Tadtg D'atricC
zo
as o( Is �he aPP6rant the sde
^ 3 gal w equibde ameR
/� ❑ Yes ❑ No
wIM whan
Is P�PenY in questim: Mnualy Assessed
Real ProveM ❑ !�!+aM �
Dra�ti�er NO.C7Q�..°.2.-.......
C�rd NO. ....r.`�.1oJ`O
Sig(unne ot Co�mHnWitcr I Counry I Date (�'^�. daY,Yea�
I I We certfy under the penalty of perjury that the above and foregoing infortnatlon is W e and cortect arW Nat the applirant is a resident of Indiana ard
owner / wntract buyer of the atorementioned property on date application is filed.
(ovmefs � nar�) � Date (r+unfh. daY.Y��
Fu0 2s2ident adtlre� W appf�Cant (num6e� arH sbee( ary, atate, erM LP catle)
(2 J �trntv �� Lf'n.nv�"�i= '�n/. �%L
PusonauWarzeCOyEWyezewted rafAttm�eyarbylCG7.7-72-0.7
AdAmss of aNhu'¢ed person (numberantl sLeet, d(y; slate, aiM LP mde)
Date (month. tleY. Y��
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